Closing hospitals can help us save the NHS

Those with the least “source force” or political clout (the soft targets) will suffer most. The distance between inpatient psychiatric care will increase. The medical care of prisoners will get worse. Despite the evidence that the public would rather have convenience than better outcomes. (Citizens prefer to die early (as a group) rather than to have services at inconveniently distant from them. ) The Utilitarian approach is needed but only after politicians have admitted we cannot have Everything for everyone for ever, and that overt rationing is needed. The obvious specialisation is in strokes where those closest to tertiary centres will get the best treatment option, and the best results..

Rachel Sylvester opines in The Times 29th November 2016: Closing hospitals can help us save the NHS – We should stop the kneejerk reactions and accept that more specialised services save money and are safer for patients (If you have time read the correspondence. Mostly from the informed city dwellers, they are in favour of closures. But those in the country and with a “community hospital” will not change their minds..)

‘You can declare war more peacefully than you can reform a healthcare system,” writes Ken Clarke in his memoir Kind of Blue. According to the former health secretary, hospital closures always provoke the bitterest battles. As soon as he embarked on a reorganisation in the 1980s he “became immersed in a constant round of demonstrations and petitions fighting to ‘save’ clapped-out institutions all over the country”.

On one occasion he had to force his way through a crowd holding placards outside a maternity hospital that was due to be shut. Although the local MP privately told him it had been a “terrible mistake” not to close the place years ago, and the senior obstetrician gave him his clinical view that it was “dangerous and unsuitable”, neither of them would back him up in public. Mr Clarke describes how a newborn baby born at the hospital was thrust into his arms as he addressed the protesters. “Clutching the baby nervously and hoping I was holding it the right way up I was then interviewed by the local television crew,” he recalls.

As affable as he is resilient, Mr Clarke relished every fight — his greatest dread was “a long, quiet, uncontroversial tenure of office in any department”. But even he was shaken by the hostility to hospital closures.

Now it will be Jeremy Hunt under fire. Having seen off the junior doctors’ strike, the health secretary is about to preside over a shake-up that will see hospitals closed, maternity units axed and A&E departments downgraded all over England. Although the details are still being finalised, it seems certain that thousands of hospital beds will disappear in the search for £22 billion of efficiency savings by 2020.

So far 33 out of 44 areas have published their “sustainability and transformation plans” and the rest must do so before Christmas. Under the proposals, which are out for consultation, one of the five acute hospitals in southwest London could close, along with three community hospitals in Leicestershire, four in Devon and three in Dorset. Other institutions will have services such as emergency stroke care removed as part of a drive to create specialist centres of excellence.

Theresa May has instructed Mr Hunt to prevent a high-profile row over hospital closures, but it’s hard to see how he can control the backlash. Even though the plans have been drawn up by local NHS bosses rather than ministers the government will still get the blame. Mass protests are inevitable as details of the changes are firmed up — indeed, 4,000 people recently marched against planned changes to Barnstaple hospital in Devon, and campaigners in Cumbria are warning that mothers and babies will die if they have to travel 40 miles from Whitehaven to Carlisle for care.

MPs, who are aware of the strength of public feeling, have already started to lobby the Department of Health to protect hospitals in their constituencies. They all remember the 18,000 parliamentary majority won by the independent candidate Richard Taylor in the Wyre Forest constituency at the 2001 election after he campaigned on the single issue of restoring the accident and emergency department at Kidderminster hospital.

Politicians are haunted by hospital closures, and the voters are fixated on protecting their local NHS, but we must all be rational rather than emotional about the provision of healthcare. There is a looming winter crisis in the health service and an impending disaster in social care as a result of local government cuts. The financial problems facing hospital trusts are matched by a growing workforce gap. Only a quarter of managers are confident they have the right mix of staff numbers, quality and skill to deliver proper healthcare, according to a survey published today by NHS Providers, which represents hospital trusts.

“However strongly people feel about their local NHS, the service cannot stand still,” says Chris Hopson, the chief executive. “There are thousands of people who are in a hospital bed who don’t need to be there.”

It is time to stop fetishising hospitals as the only way to deliver care and think about how best to allocate resources in the 21st century. It costs £400 a night to keep someone on a ward — money that could often be better spent elsewhere — but this isn’t just about cash. Nobody seriously wants to spend more time than they have to in an institution where they are at risk of infection and have no privacy. With long-term conditions such as dementia and diabetes eating up a growing proportion of the budget, money needs to be liberated from buildings and beds so that it can be redirected to looking after people at home.

In any case, the evidence — as opposed to the emotion — shows that centralising services can be the safest as well as the most efficient way to treat patients. In 2010, stroke units were closed in some London hospitals and resources concentrated in eight specialist centres. Despite the protests, almost 100 more people now survive every year as a result of the expert treatment they receive. After the centralisation of trauma care, the chances of surviving a serious accident have risen by 50 per cent.

Professor Naomi Fulop of University College London, who assessed the changes to stroke services in London, is convinced that this is a model that should be replicated around the country. “It may seem counterintuitive for an ambulance to drive a critical patient straight past the nearest hospital, but it saves lives,” she says.

In Grantham, the local hospital trust has announced that it is closing its A&E unit at night because it does not have enough doctors to run the department safely. With paramedics able to treat patients in the ambulance on the way to hospital, it may be better to have fewer A&E units but make sure those kept are properly staffed by experienced consultants.

Labour MPs who want to blame the Conservatives for hospital closures should remember that such a rationalisation was first proposed by the well-respected surgeon Lord Darzi, who became a health minister under Gordon Brown and is a Labour peer.

The crisis in health and social care means this is not a moment for local protectionism — a kind of nimbyism of the health service — nor for political short-termism from MPs who know what is needed but don’t want to admit it to their constituents. Closing hospitals may be the only way to save the NHS.

Civil unrest will be inevitable… This is the future … “Super-surgeries with 50,000 patients” – take it or leave it..

The rich get richer … and the poor get shorter lives, less choice, but more local care.

Local politics and health: Hundreds from West Wales (Pembrokeshire) to protest at the Senedd against ‘downgrading’ of Withybush Hospital

Sustainability and transformation (rationing) plans – surely STPs deserve a better acronym…

Spineless politicians should agree rationing with local communities, not behind closed doors.

Surge in twins linked to obese young mothers: UK is one of the worst places in western Europe to be pregnant and have a baby: a ‘no go’ area for a politician but we should break out of the consensus on the NHS and learn from other countries..

Making rural hospitals sustainable – It is both quality hospital doctors and GPs we are short of… Please don’t be tempted to reduce standards..

Nine health secretaries attack government for failing mentally ill –

Smitha Mundasad  for BBC news 29th November reports: Thousands ‘miss out on stroke treatment’

 

 

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This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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